Approved immunotherapeutic agents (for lung cancer)

In 2015, the PD-1 checkpoint inhibitors pembrolizumab and nivolumab received FDA approval as second-line treatment for metastatic squamous and nonsquamous NSCLC. Pembrolizumab is an option for patients whose tumors express PD-L1 and who have had disease progression after treatment with a platinum-based chemotherapy regimen. Nivolumab is also used to treat patients with disease progression during or after treatment with platinum-based chemotherapy.

The PD-L1 checkpoint inhibitor atezolizumab was approved in 2016 for the treatment of metastatic NSCLC in patients with disease progression after platinum-based chemotherapy; for patients with EGFR or anaplastic lymphoma kinase (ALK) gene mutations, atezolizumab may be used only if the patient has had disease progression after treatment with agents targeted to these mutations.

Lung cancer combination therapy/treatment algorithms

The NCI make the following combination immunotherapy/systemic chemotherapy treatment recommendations for advanced or metastatic lung adenocarcinoma:

Bevacizumab, carboplatin and paclitaxel;

Bevacizumab, carboplatin and pemetrexed (Alimta, Eli Lilly); or

Bevacizumab, cisplatin and gemcitabine.

Current clinical trials for lung cancer

Two PD-L1 checkpoint inhibitors are currently being investigated for the treatment of NSCLC. Atezolizumab is nearing approval for the treatment of locally advanced or metastatic NSCLC that overexpresses PD-L1, and avelumab, an investigational PD-L1 inhibitor, is in phase 3 testing.

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